1689799918 NPI number — TANYA SELENE DEL CASTILLO BA, MA, CCC, SP

Table of content: TANYA SELENE DEL CASTILLO BA, MA, CCC, SP (NPI 1689799918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689799918 NPI number — TANYA SELENE DEL CASTILLO BA, MA, CCC, SP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL CASTILLO
Provider First Name:
TANYA
Provider Middle Name:
SELENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, MA, CCC, SP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INZUNZA
Provider Other First Name:
TANYA
Provider Other Middle Name:
SELENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689799918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42835 JOLLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92592-7123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-920-4954
Provider Business Mailing Address Fax Number:
951-302-2476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42835 JOLLE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92592-7123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-920-4954
Provider Business Practice Location Address Fax Number:
951-302-2476
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  15269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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